During Cervical Cancer Awareness Month in January, Missouri Cancer Associates & Women’s Health Associates want to encourage doctors to make a strong, consistent recommendation for HPV Vaccination.

HPV: The Root Cause of Cervical Cancer

When it comes to cervical cancer, nearly all cases are caused by exposure to the human papillomavirus, or HPV. Thankfully, cervical cancer is almost always preventable. Understanding more about HPV and cervical health in general can greatly help in the prevention of this kind of cancer.

Testing for Human Papilloma Virus (HPV) has been used more frequently over the past decade in helping clinicians decide how to manage abnormal Pap test results. In accordance with national guidelines, Women’s Health Associates is using HPV testing along with Pap test (together called co-testing) to improve the sensitivity of screening Pap tests.

Specific strains of HPV are necessary for the development of cervical cancer. Unlike other forms of cancer that can be attributed to hereditary influences, cervical cancer is largely caused by environmental factors (the presence of HPV). In fact, women without the specific high-risk strains of HPV have virtually no risk of developing cervical cancer.

Pap tests alone identify potentially abnormal cells on the cervix, but further testing, often including biopsies, is then necessary to: 1) confirm the actual presence of abnormal cells and 2) determine if the abnormality is a benign change that can be followed conservatively or if the abnormality is a precancerous change that requires closer follow-up or treatment. With co-testing, there’s potential to find more high-risk abnormalities sooner (if HPV is positive) and the opportunity to avoid unnecessary biopsies (if HPV is negative).

Only certain strains of HPV cause cancer. Other strains (low-risk strains that are not tested for) may cause genital warts or benign changes (not precancerous) in the cervical cells, which will also cause an abnormal Pap test. It is exceedingly rare for HPV to cause problems in pregnancy for baby or mother. Another notable point about HPV is that it takes five to seven years for cervical cancer to develop after the initial infection.

Recommendation for Women Age 20

High-risk HPV is extremely common in younger women (under 29), but it is less likely to persist. As younger women often clear HPV in a year or two, they are much less likely to develop cancer. That’s why the age to begin Pap screening was increased to 21, and routine HPV testing in this age group is not as helpful.

Because of a higher prevalence of chlamydia in women under 25, routine screening for sexually transmitted diseases is also recommended for this age group. These types of infections can cause scarring and damage to the fallopian tubes, which significantly decreases the chance of fertilization.

It is now recommended to begin Pap test screening at age 21 and to repeat Pap testing in three years, if normal. If the Pap test is abnormal, yearly Pap testing, HPV testing or other testing may be indicated.

Recommendation for Women Age 30

At age 30, Women’s Health Associates is offering co-testing (Pap and HPV). If both are negative, and if the last three consecutive Pap tests were normal, co-testing can be repeated in five years. Of course, with problems, concerns or other issues, the Pap can be repeated sooner at the provider’s discretion.

Recommendation for Women Age 30

In patients without a history of high-risk disease (precancerous lesions), it may be reasonable to stop Pap screening after hysterectomy (if the cervix is completely removed) or after the age of 65.

Screening tests offer the best chance to have cervical cancer found early when successful treatment is likely. Screening can also actually prevent most cervical cancers by finding abnormal cervical cell changes (pre-cancers) so that they can be treated before they have a chance to turn into a cervical cancer.

Although annual (every year) screening should not be done, women who have abnormal screening results may need to have a follow-up Pap test (sometimes with a HPV test) done in 6 months or a year.

Reference: Globocan 2012 (IARC)

For more information on cervical cancer prevention, please visit hpv16and18.com.

Partnering to Help Eliminate Cervical Cancer



About the authors:

Dr. Liana Makarian is a medical oncologist and hematologist with Missouri Cancer Associates. Dr. Makarian completed her undergraduate studies in human biology and mathematics at The University of Toronto in Canada. She then obtained her Medical Degree from Saba University School of Medicine in the Netherlands-Antilles, West Indies. This was followed by a co-residency in internal medicine at St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons and Memorial Sloan Kettering Cancer Center, both in New York City. Dr. Makarian then completed a fellowship in oncology and hematology at St. Luke’s-Roosevelt Hospital Center. Board certified in internal medicine, medical oncology and hematology, Dr. Makarian is interested in treating all types of cancers and blood disorders. Throughout her career, she has published and lectured on a variety of cancer-related topics, and she enjoys participating in public outreach events.

Dr. Elizabeth Wilson is board certified by the America Board of Obstetrics and Gynecology. She received her medical degree from the University of Missouri – Columbia School of Medicine in 1995 and also completed her residency at the University of Missouri Hospital and Clinics. She joined Women’s Health Associates after completing residency. Dr. Wilson is a member of the American College of Obstetricians and Gynecologists and the Missouri State Medical Association. She enjoys general obstetrics and gynecology, vaginal surgery, and laparoscopic surgery.